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What to do once your health insurance claim is denied

On Behalf of | Jul 7, 2022 | Denied Insurance Claims

Your health insurance claim has been denied. We know it can be stressful, but don’t panic. A lot of insurance claims are initially denied, but you have the opportunity to try to remedy the situation to obtain the compensation that you need to cover your healthcare expenses.

Formal legal action may not be necessary

A lot of people who have had their claim denied think that they have to take immediate legal action, but this isn’t the case. Your claim denial may be a simple mistake that you can sort out with a phone call to your insurance company. That’s why it’s important that you carefully analyze your claim denial letter and try your best to understand the limits of your policy. This will help you figure out what concerns you need to alleviate in order to have your claim approved.

By reaching out to your insurance company, you might be able to quickly remedy administrative and billing errors, too, that have led to your claim being denied. You may have to reach out to the hospital to correct something on their end, but your claim denial could be a quick fix.

What if it’s not?

If you’ve taken these steps and your claim was still denied, don’t worry. You can likely appeal your denial, which will give you the opportunity to submit additional evidence to show why your claim should be approved. This evidence might include medical records, treatment explanations, and bills from your medical providers. So, after your claim has been denied, start looking for other evidence that you can present to support your claim.

At that point, you also might want to consider whether your insurance company is acting in bad faith. To do so, keep track of your communications with the insurance company and how they’ve responded. Putting together a timeline can be a big help here.

Do you need help positioning yourself for success?

If you feel like you’ve been cheated by your insurance company, then now is the time to formulate a strategy that puts you in a strong position to advocate for yourself and claim approval. We know that can be a daunting endeavor as you’re just trying to cope with your recovery, but that’s why law firms like ours stand ready to assist.

If you’d like to learn more about what legal teams that are experienced in this area of the law have to offer, then please consider researching your representation options and reach out to those that you think would be a good fit for you and your claim.